New national health strategy marks ‘first step’ in addressing health disparities

The federal government released the first-ever National Prevention and Health Promotion Strategy this week, which aims to increase the number of Americans who are healthy at every stage of life by shifting the country’s focus away from sickness and disease and toward prevention and wellness.

The National Coalition for LGBT Health and the National Gay and Lesbian Task Force commend the strategy’s focus on empowering communities and individuals to make healthy choices and embrace preventive efforts. We also applaud its holistic approach, which encourages interventions not just in the health care and public health sectors but also in housing, transportation, nutrition, education, the workplace and the environment.

The strategy now recognizes that discrimination, stigma, and unfair treatment pose serious threats to health. It accepted our recommendation to add gender identity to the list of characteristics that are linked to discrimination or exclusion and that contribute to health disparities (the list already included sexual orientation).

It also now specifically acknowledges that LGBT people may be at increased risk for negative health behaviors, such as smoking and alcohol misuse, and negative outcomes, such as sexual assault, post-traumatic stress disorder and obesity. In addition, it recognizes the profound negative health impacts that rejection of LGBT youth by their families and communities can have, including depression, use of illegal drugs and suicidal behavior.

Because health disparities cannot be effectively addressed without more complete data on the health status of LGBT people, the Task Force and the National Coalition for LGBT Health Coalition also applaud the strategy’s adoption of the recommendation to enhance data collection on groups that experience these disparities.

It now specifically recognizes that “data that can help describe the health status of certain populations are limited (e.g., data on sexual orientation and gender identity, disability status),” and it commits the federal government to increasing the availability of national health data to better address the needs of these underrepresented groups.

The National Coalition for LGBT Health and the Task Force, through the New Beginning Initiative, made recommendations during the strategy’s development, many of which were accepted.

We proposed that the National Prevention Strategy include the goal of “recogniz[ing] and address[ing] the structural determinants — including legal discrimination and social stigma — of risk-taking and mental and physical health disparities.” We also recommended adding the reproductive and sexual health priority area, a suggestion the strategy accepted. In addition, we offered recommendations to improve the health and quality of life for LGBT individuals, families, and communities within each of the proposed strategic directions and priorities.

The strategy does not, however, incorporate some of our other recommendations. For example:

• It does not endorse prevention-oriented strategies to eliminate discrimination and bias-motivated violence, such as the passage and effective enforcement of nondiscrimination legislation at all levels of government and the repeal of discriminatory laws that contribute to stigma and prejudice against the LGBT community, such as the Defense of Marriage Act and state bans on marriage equality.
• It does not recommend that employers in the prevention workforce improve their cultural and communication competence by training and hiring more qualified LGBT staff.
• It does not emphasize that providers and their patients, not insurance companies, should decide what clinical preventive care is appropriate. This is of particular concern for transgender people, who may need care that is “gendered” in insurance billing codes (for example, a transgender woman may need a prostate exam, or a transgender man may require cervical cancer screening).
• It does not include a specific focus on the LGBT population in the priority areas of tobacco-free living, prevention of drug abuse and excessive alcohol use, healthy eating, and active living, despite that these areas are of vital importance to the health and well-being of LGBT people.

While these areas are not specifically addressed with regard to LGBT populations, the strategy is written broadly, so there may be efforts to address the needs of the LGBT community as the various agencies implement the National Prevention Strategy.

The National Coalition for LGBT Health and the Task Force will continue to work with the agencies to ensure that health disparities for our community are addressed through the prevention strategy.

It is crucial that government and community prevention and wellness efforts do more to address the health disparities in the LGBT community. The Task Force and the National Center for Transgender Equality recently released Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, which reveals the increased health risks that transgender and gender nonconforming people face. Respondents reported more than four times the national rate of HIV infection (2.64 percent compared to 0.6 percent in the general population). More than one-quarter of the respondents misused drugs or alcohol to cope with the discrimination they faced, and a staggering 41 percent of respondents had attempted suicide (compared to 1.6 percent of the general population), with unemployment, low income, and sexual and physical assault raising the risk factors significantly. In addition, 28 percent of transgender people had postponed medical care when they were sick or injured because of discrimination, and 48 percent had postponed needed care because they were unable to afford it.

This strategy is an important first step to addressing health disparities through a prevention model, and we appreciate the recognition that LGBT people face great health disparities and that data collection on LGBT populations is a crucial step in the effort to end those disparities. We are hopeful that the National Prevention Strategy, as it evolves over time, will incorporate the other recommendations we have submitted to address the needs of LGBT populations in the future.

You can access the full report on www.HealthCare.gov.

This entry is cross-posted to the blogs of the National Coalition for LGBT Health and the National Gay and Lesbian Task Force.